Catheter Ablation Of Premature Ventricular Contractions Research Articles

Asymptomatische ventrikuläre Extrasystolen behandeln?

Premature ventricular contractions (PVC) are acommon arrhythmia. Therapy is indicated in case of frequent symptomatic PVC or deterioration of left ventricular function. Asymptomatic patients should be evaluated critically for possible PVC-associated symptoms. Catheter ablation of PVCs in patients with normal left ventricular ejection fraction (LVEF) is safe and effective. PVC-induced cardiomyopathy should be considered in unexplained LVEF dysfunction with aPVC burden of at least 10%. If ECG and echocardiography do not clearly rule out structural heart disease (SHD) or the clinical presentation raises suspicion of SHD, cardiac magnetic resonance imaging should be performed. If SHD has been excluded, the guidelines recommend catheter ablation as primary therapy in frequent monomorphic PVC, regardless of symptoms. To prevent PVC-induced cardiomyopathy, ablation can also be considered in asymptomatic patients with aPVC burden > 20%. Also, in patients with known SHD frequent PVC can aggravate LV dysfunction and catheter ablation should be considered.

Spatial correction improves accuracy of catheter positioning during ablation of premature ventricular contractions: differences between ventricular outflow tracts and other localizations

BackgroundHybrid activation mapping is a novel tool to correct for spatial displacement of the mapping catheter due to asymmetrical contraction of myocardium during premature ventricular contractions (PVC). The aim of this study is to describe and improve our understanding of spatial displacement during PVC mapping as well as options for correction using hybrid activation mapping.Methods and resultsWe analyzed 5798 hybrid mapping points in 40 acquired hybrid maps of 22 consecutive patients (age 63 ± 16 years, 45% female) treated for premature ventricular contractions (PVCs). Median PVC-coupling interval was 552 ms (IQR 83 ms). Spatial displacement was determined by measuring the dislocation of the catheter tip during PVC compared to the preceding sinus beat. Mean spatial displacement was 3.8 ± 1.5 mm for all maps. The displacement was 1.3 ± 0.4 mm larger for PVCs with non-outflow-tract origin compared to PVCs originating from the ventricular outflow tracts (RVOT/LVOT; p = 0.045). Demographic parameters, PVC-coupling-interval and chamber of origin had no significant influence on the extent of spatial displacement.ConclusionEctopic activation of the ventricular myocardium during PVCs results in spatial displacement of mapping points that is significantly larger for PVCs with non-outflow-tract origin. The correction for spatial displacement may improve accuracy of radiofrequency current (RFC)-application in catheter ablation of PVCs.

Cardiac MRI structural and functional predictors of left ventricular ejection fraction recovery following PVC catheter ablation

Frequent premature ventricular contractions (PVCs) can induce cardiomyopathy (PVC CM). We sought to use cardiac magnetic resonance imaging (CMR) to quantify changes in cardiac structure and function of cardiomyopathy patients following catheter ablation for PVCs. Patients undergoing PVC ablation at the Johns Hopkins Hospital with pre-procedural CMR from 2010 to 2018 were included in this study. CMR Images were analyzed to collect information on cardiac structure and function as well as to quantify scar. Of the total 51 included patients, PVC CM (LVEF < 45%) was observed in 51% (n = 29). Of these, 19 had post-ablation ejection fractions quantified, with 78.9% (n = 15) recovering function. Global longitudinal strain was significantly correlated with LVEF (OR 1.831, p < 0.01) but did not predict recovery of function. RV origin of PVCs was more common in the preserved LVEF group but was also significantly correlated with persistently reduced EF post-ablation in the PVC CM group. Scar burden was not correlated with either cardiac function or post-ablation recovery of function. In this cohort, there were no significant CMR findings to predict subsequent recovery of EF after ablation among those with PVC CM. PVC origin in the RV was associated with persistently reduced LVEF after ablation.

Catheter ablation of premature ventricular contractions in elderly patients: feasibility and success.

Catheter ablation has become a standard curative treatment for symptomatic, drug refractory premature ventricular contractions (PVC). The aim of this study was to investigate the efficacy and safety of this procedure in elderly patients. A total of 101 consecutive patients (mean age 50.7±16.9, 53% women) presenting to our center for ablation of PVC were included and assigned to two age groups (<65 and ≥65years). Clinical characteristics, procedural parameters, complications and success after 6-month follow up were compared between the two groups. Patients ≥65years (n=27) showed a higher rate of hypertension (78 vs. 27%, p<0.001), coronary artery disease (19 vs. 12%, p=0.01), renal insufficiency (22 vs. 1%, p<0.001) and diabetes (22 vs. 3%, p=0.001). Left ventricular ejection fraction did not differ between the two groups (56.6 vs. 57.4%, p=0.497). In patients <65years the origin of the PVC was significantly more often in RVOT or LVOT (95 vs. 70%, p=0.001). Acute success rates (67 vs. 73%, p=0.545) and success rates after 6months (81 vs. 86%, p=0.795) were not different between the two groups. Two complications were observed, both occurred in the <65years group (1 pericardial effusion and 1 large groin hematoma). Catheter ablation of PVC is feasible in elderly patients without overt heart disease. Success rates are not significantly different compared to patients <65years. Procedural complications are rare in both the groups. Ablation of this arrhythmia can therefore be regarded as a promising curative treatment in advanced age.